Individual provider Active NPI

Ryan Bodine, LCSW

  • Clinical Social Worker
  • Hicksville, NY
National Provider Identifier
1255886966
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
091020 Issued in NY
Practice address
28 E Old Country Rd
Hicksville, NY 11801-4292
Phone
(516) 519-2826
NPI assigned
Aug 23, 2016
Last updated
Apr 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 091020 NY Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

28 E Old Country Rd
Hicksville, NY 11801-4292

Mailing address

2 S Park Dr
Massapequa, NY 11758-2447
Phone (516) 519-2826

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211110001430 NY Practitioner - Clinical Social Worker 3779972930 Practice locations: Hicksville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
State University of New York at Stony Brook, School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

28 E Old Country Rd
Hicksville, NY 11801-4292
Phone (516) 519-2826

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Clinical Current Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ryanbodine@tdh.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1255886966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S PARK DR",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582447",
            "telephone_number": "516-519-2826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 E OLD COUNTRY RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014292",
            "telephone_number": "516-519-2826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODINE",
        "first_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-23",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "091020",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hicksville, NY

Sources for this page

Verify at the official NPI Registry.